Thursday, February 28, 2013

For those not yet convinced about the dangers of sugar, look no further than today's New York Times op-ed page with Mark Bittman's column "It's the Sugar, Folks." Bittman cites a study from the journal PLoS, released yesterday, strongly linking higher sugar consumption with higher levels of diabetes (the study deals with type 2, not type 1). "The study demonstrates this with the same level of confidence that linked cigarettes and lung cancer in the 1960s," Bittman writes.

In the study the authors found that when comparing the diets of people from 175 different countries, each 150 calorie per day increase in sugar consumption--that's one twelve-ounce can of soda--resulted in a 1.1% increase in the rate of diabetes. (By contrast, each 150 calorie increase of non-sugary foods resulted in a statistically insignificant 0.1 increase in the diabetes rate.)

One of the study's authors, Robert Lustig, is the same scientist whose work formed the basis of Gary Taubes's argument in his New York Times Magazine piece "Is Sugar Toxic?"

For Bittman, this latest study answers that question definitively. "The next steps are obvious, logical, clear and up to the Food and Drug Administration. To fulfill its mission, the agency must respond to this information by re-evaluating the toxicity of sugar, arriving at a daily value--how much added sugar is safe?--and ideally removing fructose (the “sweet” molecule in sugar that causes the damage) from the 'generally recognized as safe' list, because that’s what gives the industry license to contaminate our food supply."

So it may be that Bisi is ahead of the curve, and that things will change more quickly than I'd thought. I hope so.

Wednesday, February 20, 2013

A few mornings ago, at Jamie’s third grade
breakfast share, about half of the items had chocolate, or some other
ingredient that in another context could be classified as dessert. Chocolate
chip waffles, chocolate chip shortbread, mini chocolate chip raspberry muffins
(delicious!), chocolate chip bread, and donuts with sugary pink icing and candy
dots sprinkled on top. We brought the low-carb, low glycemic, gluten free
blueberry muffins that I mentioned in a previous post. Only three out of the
dozen I brought were left, but I know for a fact that Bisi ate three of the
muffins and Mark ate two, so they were not a popular item outside our family. Now,
I love a good chocolate croissant or chocolate chip scone as much as the next
person, but it’s kind of shocking once you start really thinking about how much
sugar most of us consume, how integral it is to our daily lives, and how
“special occasions”—like a breakfast share, or a birthday party, or valentine’s
day, or family dinner at a friend’s house, or…, or…---almost always involve an
extra helping or two. I’m not saying anything new here, but sugar is
everywhere—many kids eat it at breakfast, lunch, and dinner, and at snacks in
between. It’s in some of our bottled water and it’s in our bread. This last is
something I never thought about until an Australian friend mentioned to me that
he and his family had started making their own bread while in the U.S., since
all the bread here tasted too sweet. The food writer Marion Nestle wrote
that anything with more than about 15 carbs of sugar should be considered dessert;
and by that standard, many kids eat dessert more than five times a day. (This was
passed along to me by my friend Gina, who has been researching and thinking about this issue for years, but, as she says,
railing against how much sugar we all eat is a lonely battle that makes you
seem like a kill-joy, not least to your kids.)
Sugar consumption is something I was vaguely
worried about before Bisi was diagnosed, but it wasn’t something I thought
about a lot—unless Gina and I were talking about it. As I’ve written before,
type 1 diabetes, as opposed to type 2, is an auto-immune disorder; it’s not
caused by eating too much sugar. But there’s no doubt that refined sugar spikes
Bisi’s blood glucose high and fast, and that she needs extra insulin to cover
it. (Lower glycemic sweeteners such as agave and coconut nectar have a gentler
effect on her.) And I also wonder whether someone who’s pancreatically
challenged like Bisi could stave off the onset of diabetes by drastically
cutting down on their sugar intake.
So it’s clear why I’m now worried about sugar. But according to an article by Gary Taubes that ran in The New York Times
Magazine a couple of years ago, all of you should be too. I’m summarizing a long article into a couple of sentences here—you should read
the article if you haven’t—but he posits that refined sugar and high fructose
corn syrup, not fat, are responsible for increases over the past century in
obesity, diabetes, some cancers, and heart disease. And an article in this month’s Sky magazine talks about the links between consuming sugar and
disease, and cites a 2009 study by the American Heart Association that men
should eat a total of nine teaspoons
of sugar per day and women only five. At four carbs per teaspoon, that's the amount in a half-cup to a cup of ice cream.
The mechanism is complicated, but essentially it
involves overtaxing the liver by asking it to process more and more fructose,
which in turn means that the body becomes resistant to insulin and must produce
more and more to combat the sugar. So it’s a vicious cycle. Scarily, for the
parent of a diabetic, Taubes argues that it’s the excess insulin that spurs tumor growth and heart disease. It’s easy not to
think about how much insulin your body needs to process the sugar you’re eating
when everything works seamlessly and internally. But if I have to give Bisi an
extra unit of insulin so she can eat a pink-frosted donut with candy on top at
her brother’s breakfast share…well, maybe I’ll just give her the low-carb not
very sweet muffin I made instead. (Of course, since she’s gluten-free, she
can’t have the donut anyway—now you see one of the reasons why the gluten-free
diet comes in handy.) Eating the healthy muffin rather than the tempting donut
requires real willpower on Bisi’s part. I asked her recently how she thinks
about sugar and she said, “I like to eat sweets but I know it’s bad for me.” “So
what do you think the solution is?” “To cut down on sweets and to not always
eat them even if your friends are.” And here’s one of the hard things: because
of our society’s sugar obsession, when Bisi cuts down on it for her health,
that becomes another thing that sets her apart from her peers.
I’ve read that once you start to eat less sugar, your taste for it shrinks too. I feel
like I’ve seen that in Bisi, and in myself. That Ben and Jerry’s Mint Oreo that
used to be my favorite flavor now tastes too sweet, and I prefer Breyer’s mint
chocolate chip (23 grams of sugar versus 17 grams). But I don’t want to pretend
that we’re healthier or more virtuous than we are. We’ve cut out the occasional
Dunkin Donuts snack; we’ve cut out the weekly trip to JP Licks for ice cream.
We’ve cut out the big glob of maple syrup on the oatmeal in the morning. But
our kids still eat sugar—probably much more than American kids of a century
ago, or than present day kids in other countries. According to one estimate,
Americans in 1822 consumed an average of 6.7 pounds of sugar a year.
Today, it’s over a hundred pounds. Again, it’s a balancing act. Sugar is such
an integral part of U.S. society today that keeping Bisi from eating it would
not only make her miserable, but make her feel like something of an outcast.
Maybe at some point society will move in our direction; or, when Bisi’s older,
maybe she’ll make a choice on her own to strictly limit her sugar intake. But
for now, we’ll try to eat sugar wisely, and when we have it, we’ll make sure
that it tastes good enough that the choice is worth it.

---
When Bisi was in the hospital, one of the nurse
educators we met with suggested that we spend some time in the supermarket
aisle, looking at labels to see which treats are a good fit for someone who
should be limiting her carbs. Here are a few of the ones we’ve found and like.
None of these listings are sponsored—I wish they were. Buying healthy food is expensive!

Yogurt: I
always used to give the kids Brown Cow yogurt, but the brand I tend to buy now
is Oikos Organic. Their strawberry and blueberry yogurts, at 16 carbs, are less
than half what some other yogurts are. And the smaller Oikos vanillas, at 9
carbs, are even better.

I was thrilled one day to find Siggi’s Icelandic
yogurt—11 carbs each, and sweetened with agave, which has a much lower glycemic
level than sugar. But, unfortunately Bisi doesn’t really like them—they’re too
sour. Maybe if I can get her sugar needs down further I’ll try again. Stay
tuned for Mark’s efforts to make our own yogurt—the machinery has arrived, but
the experiments have yet to begin.

Ice
cream, yes, ice cream. I’ve found that ice creams, too, vary considerably
in terms of how much sugar/how many carbs they have. If Bisi’s going to a
birthday party, Hoodsie’s are a good thing to send with her, since she can’t
have the cake. They seem special, since they come in those cute little cartons.
And the portions of them are relatively small—about half a cup. I’ve found that
Breyer’s ice cream tends to be lower carb than many other brands. Note that
some sorbets have more than double the amount of sugar that many ice creams do
(because they’re all fruit and sugar, rather than dairy and sugar).Popsicles: We like the Smooz fruit pops, at 11 carbs. And Lifeway’s 13-carb
frozen kefir pops, with probiotics.Kind Bars: The carb counts of these vary widely, but some of them are as low as
14 carbs, and they’re a great snack since they’re full of nuts (protein), they
aren’t very sweet (usually about 5 grams of sugar), and they’re high in
fiber--fiber counteracts carbs. Unfortunately, whether Bisi likes these is
mood-dependent.

Cereal: Purely Elizabeth: a gluten free granola sweetened
with coconut sugar with various ingredients that are supposed to be great for
you, like chia seeds, amaranth, and quinoa.

I recently discovered Seitenbacher gluten-free
muesli #6. I like it because Bisi likes it and because it’s low carb, high in
protein, and high in fiber.

Also, at a farmer’s market in Seaside, Florida,
we tried and bought an incredibly delicious cereal/snack called Veronica’s Health Crunch, including pecans, pumpkin seeds,
coconut flakes, a little sweetening, and a little salt. It’s gluten free, very
low carbs, high protein, high fiber—ie, a perfect snack for Bisi. Now we just
have to get her to like it.Gluten-free baking products: As I mentioned in a previous post, I love the
products made by Bob’s Red Mill. But, as my friend Emily Moore, author of the
diabetes blog Icarus and Daedalus, commented
on that same post, gluten-free products often have as many if not more carbs
than regular products. Fortunately, Bob’s sells several nut-meals that are very
low carb, and that can be substituted for most other flours (though the
consistency is moister). The one we’ve used the most so far is almond flour,
though hazelnut is also good.Breads: Some of the gluten-free breads (I won’t name
names) really shouldn’t be called bread. Instead, think of something that has
the consistency of flavorless, unsweetened pound cake. But so far I’ve found
two brands that Bisi really likes: Udi’s and Glutino. You have to check the
labels of each kind, some are higher carb than others, but the ones we buy have
10 or 11 carbs per slice. That’s half the amount of the regular bread I buy for
Jamie. Often, if I’m making a grilled cheese for myself, I’ll voluntarily
choose the gluten free.Suggestions Needed: Do you have any suggestions for good,
gluten-free, relatively low carb snacks and/or desserts? Either sweet or not?
If so, please pass them along. Bisi is constantly deciding that she doesn’t
like a snack she once liked, so we are in constant need of new ideas.

Tuesday, February 5, 2013

I haven’t talked all that much about Jamie, our 8-year-old
son, in these posts, but not because Bisi’s diagnosis doesn’t affect him. He
has had to deal with the fear of Bisi and me suddenly disappearing to go to the
hospital; with the attention before meal times shifting dramatically in her
direction, as we talk about what she’s going to eat, test her blood sugar, and
give her some insulin, and with the worry and sense of fragility her diagnosis
has brought into our lives (even if he wouldn’t express it that way). He asked
me once if Bisi’s diagnosis meant that he could get diabetes too. I told him
that anyone can get T1D, but that it’s not likely that he will. The truth is,
he is at greater risk, because he has a first-degree relative with T1D. But if
you had sat me down a year ago, explained T1D to me, and asked me which one of
my children seemed more likely to get it, I would have immediately said Bisi,
because of the way her moods fluctuate when she’s hungry. This is not based on
anything scientific, but it just means that I am not going to spend my time
worrying that this will happen to Jamie.

I think it’s probably a good thing that all of us are eating
less sugar than we used to. But I also don’t want to limit Jamie just
because there are limits on what and when his sister can eat. My very possibly
imperfect solution so far has been to let Jamie have some treats when he’s not
with Bisi. He and I have a standing date at the local frozen yogurt shop while
Bisi’s otherwise occupied; and we follow a don't tell, hope she won't ask policy. Or, when he’s having something that she can’t have
at home, I try to come up with a substitute she’ll be excited about, or excited
enough about. So, say, if he’s getting a hot chocolate, I’ll make her one with
stevia (a natural sugar substitute made from the leaf of the stevia plant, which
to me seems more inherently healthy than aspartame or saccharine).

Yet still, nothing drives Bisi crazier than the feeling that
Jamie is getting something that she can’t have—even if it’s something she
doesn’t want. Whatever food-related anger she has—and she must have a fair
amount—she focuses intensely on Jamie. She’s furious if he starts eating before
she does, while she’s still waiting for her insulin to kick in. She can’t stand
it if he gets a more appealing dessert than she does. I feel like Mark or I
could be across the table eating an ice cream sundae with whipped cream and
sprinkles and she wouldn’t care, as long as her brother is eating the same 13
carb frozen yogurt that she is. These are typical sibling dynamics in action:
if something is happening to you, you want it to happen to your sibling too. (I
remember when my sister once got a hair cut she hated and kept on pointing at
me and yelling, “Cut her hair!”, as if my having a terrible hair cut were the
only thing that would make hers bearable.) Yet the fights over food feel especially
fraught, because what they’re really about is that Bisi’s facing something
difficult that Jamie doesn’t have to.

Jamie usually reacts to Bisi’s food outbursts with a look of
detached bemusement. But he loves her
and occasionally he does something very sweet for her. One day we were sitting
having snack, and Jamie ran up to his room and came down with $10 from his
stash and handed it to Bisi. (We give both kids $3 of allowance each week, and
expect them to use that money to buy themselves the things they want, in
between Christmas and their birthdays. Jamie never spends his; whereas Bisi
almost always spends hers the moment she gets it.) I asked him why he’d given
her this unsolicited gift and he said, “Well, because she’s going through a
hard thing. Diabetes is hard, isn’t it?” Another time, he decided he wanted to
bake cookies, and said he wanted to make
them gluten free, so Bisi could have them. We looked through some recipes and
settled on one from Bob’s Red Mill (whose products I love—more on that in
another post), printed on the back of a package of teff flour, made from the seeds of a type of grass native
to North Africa. Jamie completed every
step of the process himself, and in the end, the cookies were
delicious—nutty-tasting and not too sweet. The only person who didn’t like them
was … Bisi. But even a six year old can
understand the idea that it’s the thought that counts. And for that day, at
least, sibling harmony reigned.

***

Jamie’s Cookies for Bisi

(I altered the recipe I found on the back of the package of
Bob’s Red Mill teff flour; the orginal recipe is from www.lesliecerier.com)

1 1/2 cups teff flour

½ teaspoon sea salt

½ cup coconut nectar (the original calls for maple syrup,
but coconut nectar is supposed to be better for diabetics because it causes a
more gentle spike in blood sugar)

In a food processor blend coconut nectar, oil (you’ll have
to melt it first), vanilla and peanut butter. Add the wet ingredients to the
dry ingredients; blend well. Shape dough into walnut size balls. Place on
cookie sheet and flatten gently with the tines of a fork. Bake about 13-15
minutes. Cool on wire rack.

About Me

It had never occurred to me to blog about anything until my daughter was diagnosed with type 1 diabetes. There's a lot swirling around in our heads and a lot to figure out; blogging seemed like a good way to help that process along. I'm a freelance writer of profiles, features, and book reviews; and a former magazine editor who still does some editing work.